Stomach (Gastric) Cancer

Overview

Getting treated for stomach cancer at City of Hope means your care is in the hands of world experts in robotic and minimally invasive surgery and precision medicine. It means comprehensive, multidisciplinary care from physicians offering the newest and best treatments for both early and late stage disease.

And our commitment to high quality, personalized care means we place your concerns and quality of life at the center of your treatment.

Request a consultation

City of Hope’s world renowned stomach cancer care team uses the latest technology and innovation to treat cancer while providing compassionate care. Call 800-826-HOPE or request an appointment online.

City of Hope is one of only a few high-volume centers for gastric surgery in the country and our patients have access to some of the most promising new therapies as part of our clinical trials program.

Highlights of Our Stomach Cancer Program Include:

Minimally invasive procedures, including laparoscopic and robotic surgery, that result in less pain and quicker recovery

Surgeons expert at performing operations like D2 lymphadenectomy, a complex and more extensive method of removing disease-containing lymph nodes

Clinical trials, including combining immunotherapy with radiation therapy, to bolster the immune system response to fighting cancer

Palliative procedures designed to improve quality of life

City of Hope’s team of surgeons, gastroenterologists, medical oncologists, nurses, radiologists, and genetic and nutritional counselors work together closely at all stages to provide seamless, coordinated care. We balance that approach with personalized medicine — not just when it comes to your cancer, but the kind that makes you feel supported throughout your treatment.

When we care for you at City of Hope, we are not just focused on leading-edge care and innovation — we are working to make you whole again.

Stomach Diseases We Treat

Stomach (Gastric) Cancer

Adenocarcinoma

Precancerous lesions that may develop into adenocarcinoma

Dysplasia

Metaplasia

Gastrointestinal stromal tumors of the stomach
Neuroendocrine tumors of the stomach

Carcinoids

Gastrinomas

Other less common types of stomach cancer

Squamous cell carcinoma

Giant cell carcinoma

Lymphoma

Noncancerous tumors of the stomach

Leiomyoma

Schwannoma

Lipoma

Hyperplastic polyps

Inflammatory polyps

Hamartomatous polyps

Top cancer hospital

City of Hope is internationally recognized for its research and breakthrough treatments, has been named one of America’s top cancer hospitals by U.S. News & World Report for over a decade and is a National Cancer Institute-designated comprehensive cancer center.

We are one of only a few dozen centers in the country that treat stomach cancer using a comprehensive approach — by a team whose sole focus is treating this type of cancer. Your care includes regular interaction and input from a team that includes surgeons, oncologists, gastroenterologists, radiologists and pathologists — along with nurses, social workers, nutritionists and specially trained support staff. And we provide nutritional counseling, physical therapy and spiritual support at all stages of treatment.

Providing the best available treatment options for every one of my gastric cancer patients – and offering hope, whether it is with curative surgery or combination of therapies — I find that to be the most enriching part of my day. Yanghee Woo, M.D., surgeon

Stomach cancer — also called gastric cancer — is a rare disease in the United States, however it is a leading cause of cancer death worldwide. Nearly 1 million patients worldwide will be diagnosed with stomach cancer this year. About 26,000 of those cases will be diagnosed in the United States, according to the American Cancer Society.

Types of stomach cancer

Adenocarcinoma is the most common type of stomach cancer; it starts in the inner lining of the stomach, called the mucosa. Between 90 to 95 percent of stomach cancers are adenocarcinomas.

The two types of gastric adenocarcinoma include:

Intestinal type is usually found in the lower portions of the stomach. This type tends to arise from chronic inflammation — with a well described malignant transformation of normal mucosa – and has a strong association with H. pylori infection.

Diffuse type is an aggressive form of cancer in which cells (that never come together to form tumors) scattered throughout the stomach grow and spread rapidly. This form is more commonly found in the upper portions of the stomach or involves the entire stomach. Some patients with inherited conditions are predisposed to developing diffuse type gastric cancer.

Less common stomach cancers

Gastrointestinal stromal tumors start in special cells found in the wall of the gastrointestinal tract, called the interstitial cells of Cajal. This type of tumor — whether benign (not cancerous) or malignant (cancerous) — is commonly found in the stomach.

Carcinoid tumors are tumors that start in hormone-making cells in the stomach. Most of the time they do not spread to other parts of the body.

Lymphomas are cancers that typically start in immune system cells but can also start in the stomach wall.

Other rare cancers can start in the stomach, including squamous cell carcinoma, small cell carcinoma and leiomyosarcoma.

How Stomach Cancer Develops

The stomach is a large pouch – shaped like a “J” – that connects the esophagus to the intestines, and is where the food you eat is partially digested before being passed through to the small intestine. It expands and contracts and has the capacity to hold a large volume of food and fluids.

Stomach cancer develops when cancer-causing substances from foods come into contact with the layers lining the stomach, or when a condition that causes inflammation (an abnormally sustained immune response) changes the character of the stomach lining. There a few conditions that may lead to this disease:

Helicobacter pylori infection, or H. pylori, is a type of bacteria that causes stomach infection. It may be involved with changes to cells that turn them from normal to cancer.

Chronic atrophic gastritis creates problems in the immune system, causing it to attack cells in the stomach wall. This condition is related to H. pylori infection and may lead to cancer, but it is not known exactly how.

Intestinal metaplasia leads to changes to cells that line the stomach, so that they resemble cells in the intestine. This condition is suspected to play a role in stomach cancer.

Intestinal dysplasia are premalignant lesions that may transform into cancer over time if left untreated.

What Increases Your Risk of Stomach Cancer?

Things that put you at higher risk for getting stomach cancer are called risk factors. Since the main role the stomach plays in the body is digesting food, an important risk for developing this type of cancer is related to what you eat. Other things like genetics, age and whether you smoke also play a role. Some major risk factors for getting stomach cancer include:

H. pylori, a type of bacterial infection affecting the inner lining of the stomach that can lead to inflammation (an immune system response that lingers for too long) and peptic ulcers. It is found in most stomach cancer patients.

Previous stomach surgery, including having part of your stomach removed for reasons other than cancer, increases risk.

Industrial chemical exposure that comes from working in dusty and/or high temperature processing environments — or being exposed to certain chemicals like chromium — is associated with a higher risk of developing stomach cancer.

Smoking cigarettes is linked to an increased risk of developing stomach cancer.

Blood type A is associated with an increased risk of stomach cancer.

Age is a risk factor for stomach cancer — most people are diagnosed in their late 60s or older.

Stomach Cancer Symptoms

During early stages, stomach cancer may not cause any symptoms, or they may not be specific — like indigestion or stomach discomfort that does not go away. Since these symptoms mimic other, less serious conditions, many people may dismiss them.

Early stomach cancer symptoms

Indigestion

Reduced appetite

Heartburn

Mild nausea

Later stomach cancer symptoms

Symptoms may be different during later stages and can affect other parts of the body — like the liver, lungs and bones. Stomach cancer that is advanced may block the stomach or intestines. Later symptoms may include:

Sticky, dark or bloody stool

Anemia

Unexplained weight loss

Excessive belching

Vomiting

Jaundice (yellowing eyes or skin)

Fluid build-up in the abdomen

Trouble swallowing

Feeling bloated even after not eating much

Pain or burning in the belly (stomach, abdomen)

Other medical conditions, like peptic ulcers and gastritis, share these symptoms. If you are treated for these conditions and symptoms like bloating, heartburn or indigestion do not go away, you may need further consultation to rule out stomach cancer.

Stomach cancer prevention

Quitting smoking, maintaining a healthy weight and avoiding smoked, pickled, preserved and salted foods may lower your risk. Eating a diet rich in fruits and vegetables may also reduce risk and, as with many cancers, being physically active and avoiding processed foods and meats helps.

Studies are ongoing to find out if things like antibiotic treatment and eating an antioxidant-rich diet could thwart one of the biggest risks for stomach cancer: H. pylori.

At the end of the day, I really feel like I made a difference — I really made an impact in someone’s life. James Lin, M.D., gastroenterologist

Stomach cancer detection

Screening involves looking for cancer before you have symptoms and increases your chances of catching it at an early stage, when it is more likely to be treated and cured. In the United States, low rates of stomach cancer mean there is no practical reason for early screening but studies in other countries like Japan — where this type of cancer is more common — show that screening programs in high-risk groups successfully find disease when it is more treatable. Screening is most appropriate in groups of people known to have a high risk of stomach cancer.

City of Hope physicians are committed to finding and treating stomach cancer in its earliest stages. If you are concerned about persistent and troubling gastrointestinal symptoms — or you have a family history or genetic risk of stomach cancer — you may require a consultation.

Hereditary causes of stomach cancer

Inheriting certain genetic diseases puts you at risk of getting stomach cancer and being diagnosed earlier in life. Inherited conditions that influence your risk include:

Hereditary diffuse gastric cancer is rare, but when it is found the risk of developing stomach cancer is between 70 and 80 percent. A problem with a gene called CDH1 causes this type of stomach cancer, and in women it is associated with a higher risk of breast cancer.

Lynch syndrome, also called hereditary nonpolyposis colorectal cancer, is a condition that also increases the risk of stomach cancer. Problems with genes called MLH1 or MSH2 — and several others — lead to Lynch syndrome.

Familial adenomatous polyposis involves developing multiple noncancerous polyps in the colon, stomach and intestines that may later progress to cancer. This condition, caused by a defect in the APC gene, most often leads to colorectal cancer but in some cases it increases risk for stomach cancer.

BRCA1 and BRCA2 genes are more commonly associated with breast cancer, but may also increase the risk of stomach cancer.

Li-Fraumeni syndrome increases the risk of developing stomach cancer at a young age.

Peutz-Jeghers syndrome leads to polyps in several passages in the body, including the nose, lungs, bladder, stomach and intestines, and is associated with an increased risk of stomach cancer.

Although hereditary factors account for a small percentage of stomach cancers, your chances of having one of these conditions is higher if close family members, like siblings or parents, have been diagnosed.

City of Hope’s Division of Clinical Cancer Genetics offers genetic counseling and screening that can identify whether inherited conditions influence your risk — and guide you to the best treatments.

Diagnosing Stomach Cancer

Stomach cancer is a complex disease that is challenging to accurately diagnose and stage. City of Hope’s team of internationally trained gastric specialists use their clinical expertise and leading-edge technology to provide you with the most accurate diagnosis — and the most effective treatment.

Tests to diagnose stomach cancer

Upper endoscopy, the main test to diagnose stomach cancer, uses a thin tube with a camera at the end to visualize the esophagus, stomach and duodenum to check for abnormal areas. This procedure may be performed with an ultrasound to determine whether the disease has spread.

Endoscopic biopsy involves removing tissue or cells to be viewed later under a microscope by a pathologist, and usually is done during an endoscopy.

Blood chemistry studies may be ordered to check whether you are anemic. Anemia may be a result of bleeding, liver problems or poor nutrition related to cancer.

Staging stomach cancer

If cancer is suspected we may perform other tests to better visualize the cancer and determine if it has spread:

Endoscopic ultrasound is a small tube with a probe at the end that uses sound waves to construct a detailed image of the stomach and surrounding organs. EUS may be used to evaluate abnormal findings on previous tests.

A CT scan takes a series of pictures inside the body from different angles to determine if cancer has spread.

A PET/CT scan is a procedure in which a positron emission tomography scan and computed tomography scan are done at the same time. It involves injecting radioactive glucose and seeing where in the body it is used most, since malignant tumors need more glucose than normal cells.

"The goal of surgery for gastric cancer is long-term survival and maintaining the patient’s quality of life. To achieve these two goals, I use the most up to date and innovative surgical approaches tailored to each individual patient." Yanghee Woo, M.D. Surgical Oncologist

City of Hope’s approach to treating stomach cancer starts with a coordinated, multidisciplinary care team whose main goals are helping you live a long, healthy, cancer-free life. We combine leading-edge technologies — like minimally invasive, laparoscopic and robotic surgery — with the latest therapeutic and radiological advances. Our treatment approach involves:

An initial consultation with a specially-trained gastric surgeon who will lead your treatment strategy

Input from experts in various subspecialties at every stage of your treatment

Nutritional support throughout your treatment — including before and after surgery, during radiation or chemotherapy, and after treatment

Palliative care and pain management

Stomach (Gastric) cancer treatment options

For early stage gastric cancer, surgery alone is a common treatment option that involves removing the cancer and surrounding lymph nodes. For more advanced disease, your care team will discuss a plan that may involve a combination of treatments including surgery, chemotherapy and radiation. Treatments available to our patients include:

Robotic surgery for highly precise surgery with smaller incisions, less pain and quicker recovery time

Endoscopic mucosal resection, an advanced minimally invasive endoscopic procedure that is used to treat early gastric cancers with smaller lesions

Endoscopic submucosal dissection, a newer technique that can remove larger lesions at one time when compared with EMR

Clinical trials that are finding new drug therapies and combinations to treat advanced cases

Surgery

Surgery for stomach cancer depends on the stage at which the disease is diagnosed, how much of the stomach area is involved and whether cancer has spread to nearby lymph nodes or distant organs. For advanced stage gastric cancer, surgery can be challenging because of the need to remove the soft tissues surrounding the lymph nodes — and because of their proximity to blood vessels — which requires a highly specialized approach. City of Hope gastric surgeons are internationally-recognized experts on removing stomach cancer using both conventional and advanced methods like D2 lymphadenectomy and the newest endoscopic procedures.

A focus on minimally invasive techniques

City of Hope surgeons are experts at using minimally invasive techniques (especially robotic surgery) for complex abdominal operations, offering several advantages, including:

Less blood loss during surgery

Fewer transfusion requirements

Less pain after surgery

Shorter postoperative recovery

Earlier return of bowel function

Earlier discharge after surgery

Types of gastric surgery

Subtotal or partial gastrectomy removes the section of stomach that has cancer and nearby lymph nodes — and in some cases the spleen

Total gastrectomy removes the entire stomach, nearby lymph nodes, and parts of the esophagus, small intestine and other involved areas

D2 lymphadenectomy is a technically challenging procedure performed during gastric cancer surgery to remove more cancerous lymph nodes.

Other surgical options

If a tumor is blocking the stomach, preventing the cancerous area from being removed completely using standard surgery, other options exist:

Endoluminal stent placement involves inserting an expandable tube into passages that need opening. To reopen a stomach area being blocked by a tumor, stents may be placed between the stomach and esophagus, or the stomach and small intestine.

Endoluminal laser therapy is a procedure in which a laser, attached to a tube, is inserted into the body and used as a knife.

Gastrojejunostomy is surgery that involves removing a section of the stomach that is blocking the opening of the small intestine. The surgeon then creates a new path for food from the stomach to the small intestine by connecting a part of the small intestine called the jejunum to the stomach.

Chemotherapy

Chemotherapy is cancer treatment that uses drugs to either kill cancer cells or stop them from growing.

Exciting advances in chemotherapy at City of Hope are allowing patients with advanced disease to get drug combinations designed to shrink tumors, slow down disease progression and improve quality of life. And City of Hope is leading a study combining radiation therapy with chemotherapy to treat late-stage disease.

Targeted therapies

City of Hope uses the latest technology to spot genetic vulnerabilities in cancer cells and use medications — or combinations of medications — to stop them from growing. This allows us to create targeted therapies: drugs or drug combinations that would work best to treat specific cancers.

All Stage 4 gastric cancer patients at City of Hope have their tumors molecularly profiled, which means the genetic code of the patient’s specific type of cancer is dissected and used to determine the best, most individualized treatment course.

Supportive care

Having part of your stomach removed is a life-changing event. Care at City of Hope includes counseling and nutritional education, support and palliative care from our staff — who are lifelong partners in your healing.

City of Hope’s renowned physicians and researchers use the latest in technology and innovation to treat cancer, coupled with our enduring belief in providing unparalleled compassionate care. If you have been diagnosed with gastrointestinal carcinoid tumors or are looking for a second opinion consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.

Clinical trials – research studies that involve volunteer patients – are a crucial component to developing new, more effective treatments that save lives. Many of today’s standard therapies are based on the results of previous trials, some of which were initiated at City of Hope.

Stomach Cancer Research at City of Hope

Getting treated for stomach cancer at City of Hope means you are steps away from labs where new treatments for cancer are being developed every day. That proximity means you benefit from something unique in cancer care — bench to bedside treatment. “Bench to bedside” means innovative research we are conducting in our labs is moved quickly to the bedside to treat our patients.

Precision medicine

Cancers are able to survive and thrive because of genetic abnormalities that keep them from being detected and destroyed by the body’s immune system. Research is revealing the specific mutations (problems within the DNA in a cell) causing these abnormalities, and using that information to tailor therapies to specific patients’ tumor cells.

For example, with stomach cancer, recent advances have revealed ways that chromosomes in cells can rearrange — leading to inflammation, and eventually cancer. Other cellular problems may break down the stomach lining, allowing cancer to spread. Precision medicine techniques, such as those being used at City of Hope, are attempts to target those problems within cells, and disrupt the process that leads to cancer.

Clinical trials at City of Hope

Radiation therapy that is directly focused on cancerous tumors may make them more hospitable to immune system therapies targeting those same tumors. The theory is that radiation primes the tumor for targeting, while immunotherapy helps to finish the job. A new study will combine radiation therapy with an immunotherapy drug called pembrolizumab (more commonly used to treat melanoma and nonsmall cell lung cancer) to test whether the combination can work synergistically to fight late stage disease.

One way cancer cells survive is by tricking the immune system into not recognizing them. When immune cells conduct their normal checks to determine whether a cell is harmful, cancer cells have ways of evading detection. A new class of drugs called monoclonal antibodies can bind to the surface of cancer cells and make them more visible to the immune system — and do things like block cancer cell growth and blood vessel formation. City of Hope is leading a study examining whether one of those drugs (pembrolizumab) is effective alone, or in combination with other drugs, for fighting advanced stage gastric cancers.

Biomarkers are substances that, when found in the body, indicate something is present — like disease. Early studies, using blood samples from patients or samples from extracted tumors, are being used to find biomarkers associated with stomach cancer. The results of these studies may provide insight about how stomach cancer is progressing and/or responding to chemotherapy — and could one day be used as a screening and diagnostic tool.

Learn more

Stomach cancer is an extremely complex disease that can act many different ways in the body. Research at City of Hope — driven by patient-specific individualized treatment strategies — is focused on those differences, and on designing therapies that affect how stomach cancer develops, progresses and spreads. Click here to learn more about clinical research at City of Hope.

Living with Stomach Cancer

When you come to City of Hope, you have access to a strong network of support services and staff to help you and your family along your cancer journey. That support includes everything from talk therapy to meditation to being paired up with a patient navigator.